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Related Concept Videos

Healthcare Associated Infections II: Preventive Measures01:22

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Essential infection prevention measures are based on the knowledge of the infection chain, the modes of transmission in healthcare settings, and the use of the best practices in all healthcare settings. Compulsory public reporting of healthcare-associated infection rates is needed to allow individuals and the community to make informed choices regarding selecting a healthcare facility.
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Antimicrobial Stewardship Programs in Neonates: A Meta-Analysis.

Dwayne Mascarenhas1,2,3, Matthew Sai Pong Ho4, Joseph Ting4

  • 1Neonatal-Perinatal Medicine Fellowship Training Program, University of Toronto, Toronto, Ontario.

Pediatrics
|May 20, 2024
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Summary

Neonatal antimicrobial stewardship programs (ASP) significantly reduce antimicrobial initiation and duration in newborns without increasing adverse events. These programs are effective in improving outcomes and reducing resistance in neonatal intensive care units (NICUs).

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Area of Science:

  • Neonatal Medicine
  • Infectious Diseases
  • Pharmacology

Background:

  • Neonatal sepsis is a major cause of infant mortality and morbidity.
  • Uncontrolled antimicrobial use in neonates leads to adverse effects and resistance.
  • Antimicrobial stewardship programs (ASP) aim to optimize antimicrobial use.

Purpose of the Study:

  • To review the components of neonatal antimicrobial stewardship programs (ASP).
  • To evaluate the effects of ASP on clinical outcomes, cost-effectiveness, and antimicrobial resistance.
  • To synthesize evidence on the impact of ASP in neonatal populations.

Main Methods:

  • Systematic review of randomized and nonrandomized trials, observational, and quality improvement studies.
  • Searched multiple databases (PubMed, Medline, Embase, Cochrane CENTRAL, Web of Science, SCOPUS) up to May 22, 2023.
  • Extracted data on ASP components and clinical outcomes from 70 eligible studies involving over 350,000 neonates.

Main Results:

  • Moderate-certainty evidence shows significant reductions in antimicrobial initiation (19% in NICU, 8% combined) and duration.
  • Reduced length of therapy (1.82 days) and use of antimicrobials >5 days (9%).
  • Low-certainty evidence suggests reduced economic burden, drug resistance, and favorable sustainability, with no increase in sepsis-related mortality or reinitiation of antimicrobials.

Conclusions:

  • Neonatal ASP interventions effectively reduce antimicrobial initiation and duration.
  • Evidence indicates no increase in adverse events, sepsis-related mortality, or antimicrobial reinitiation.
  • ASP demonstrates potential for improving neonatal care and combating antimicrobial resistance.